# Anogenital high-risk HPV prevalence and screening considerations in female transplant recipients: a cross-sectional study

## TL;DR

Female organ transplant recipients have higher rates of HPV infections in genital and anal areas, suggesting the need for additional screening.

## Contribution

This study provides age-dependent HPV prevalence data and suggests the need for extended screening in transplant recipients.

## Key findings

- Cervical hrHPV prevalence was 15.9% with no significant difference between liver and kidney transplant recipients.
- Anal hrHPV prevalence was 20.3%, with a high co-prevalence rate of 68.8% in both anal and cervical sites.
- High-grade intraepithelial neoplasia was detected in four women with cervical hrHPV infection.

## Abstract

Organ transplant recipients receiving immunosuppressive therapy have a higher risk of developing anogenital HPV-related (pre)malignancies. This study aims to determine the age-dependent anogenital hrHPV prevalence in transplanted patients and to investigate various risk factors within this high-risk patient group.

Women (n = 201) after kidney (n = 98), liver (n = 93), and combined (n = 10) transplantation were tested and genotyped for hrHPV in the anal and cervical regions. Medical records and a questionnaire assessed sexual behaviour, medical treatment history, and demographic data.

Among our cohort the median age was 52 years (range 18–78), the prevalence of cervical hrHPV infection was 15.9% (32/201), with no significant difference observed between liver and kidney transplant recipients. Increased hrHPV prevalence was not associated with transplant-specific risk factors such as type and duration of immunosuppressive therapy, whereas typical risk factors such as sexual behaviour conferred increased risk. Anal hrHPV had an overall prevalence of 20.3%, and the co-prevalence of hrHPV detected at both anal and cervical sites was 68.8%. 90% of the patients with cervical hrHPV infection (29/32) attended clinical follow-up and high-grade intraepithelial neoplasia was detected in four women (3x CIN2+/ 1x VaIN3).

Compared to the general population, our study shows an increased cervical HPV prevalence in transplanted patients above 30 years. In addition, the baseline risk for infection with anal hrHPV is increased, suggesting that additional screening in cervical hrHPV-positive transplanted patients may be beneficial to detect (pre)invasive lesions in the anal region.

Female organ transplant recipients show a high genital hrHPV prevalence with an increased anal co-infection rate, suggesting additional screening for genitoanal lesions might be beneficial.